2011

Hospitalizing teen girls with pelvic inflammatory disease (PID) costs six times as much as treating them in the emergency room, and up to 12 times more than treating them in an outpatient clinic, according to a small study conducted at the Johns Hopkins Children’s Center.

The findings, published online in the December issue of Sexually Transmitted Diseases, are based on an analysis of 172 patient visits among 152 girls, 12 to 21 years of age, with PID.

The researchers say the study underscores the need for earlier diagnosis and treatment of these patients not only to help contain costs, but also, more importantly, to prevent PID complications like chronic pelvic pain and infertility.

“The dollar cost of PID hospitalizations and ER care is important, but at the same time we should take steps to individualize PID care and tailor it to each girl’s specific age and circumstances to help her understand how to prevent this from happening again,” says lead investigator Maria Trent, M.D., M.P.H., a Hopkins Children’s pediatrician who studies teen sexual and reproductive health.

Of the 135 outpatient visits in the study, only 14 involved visits to a regular clinic, while 121 were visits to the emergency room, probably signaling lack of reliable primary care for many of the teens in the study, the researchers say. Outpatient visits cost on average $701, compared with $1,382 for treatment in the emergency room.

By comparison, inpatient treatment in the hospital costs on average $8,480 per patient per episode. Thirty-seven of the 172 visits resulted in hospitalizations because of severe or advanced PID. Hospital charges were even higher — $13,360 — for a small subset of girls with PID who required treatment on a psychiatric unit, a finding that suggests how vulnerable sexually active teens with mental health disorders might be.

PID, an inflammation of the reproductive organs, is a complication of untreated sexually transmitted infections like chlamydia and gonorrhea, among other bacterial infections, and affects more than 1 million women in the United States each year, according to the U.S. Centers for Disease Control and Prevention. More than 100,000 of these women develop fertility problems as a result of their infections.

Co-investigators on the study included Jonathan Ellen, M.D., of Hopkins Children’s, and Kevin Frick, Ph.D., of the Johns Hopkins Bloomberg School of Public Health.

Founded in 1912 as the children's hospital at Johns Hopkins, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. The Johns Hopkins Children's Center is Maryland's largest children's hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, visit www.hopkinschildrens.org.